Endovascular Management of Aortocaval Fistulas

Endovascular approaches have revolutionised the treatment of aortocaval fistulas, offering lower perioperative morbidity and improved recovery compared with open repair. An aortocaval fistula is an abnormal communication between the aorta and the inferior vena cava that often arises spontaneously as a complication of an abdominal aortic aneurysm or less commonly after trauma or surgery. Prompt diagnosis and timely intervention are critical to prevent high-output cardiac failure, acute renal impairment and early mortality. Modern endovascular management employs stent-graft placement to exclude the aneurysmal sac and seal the fistulous tract, restoring normal aortic flow and venous return. Pre-procedural planning utilises cross-sectional imaging to assess vascular anatomy, aneurysm morphology and landing zones for the stent-graft. Technical refinements include the use of custom or off-the-shelf fenestrated and branched devices in anatomically challenging cases, adjunctive venous stenting to optimise caval patency, and intraprocedural imaging with cone-beam computed tomography or intravascular ultrasound to guide precise device deployment. Outcomes from contemporary series demonstrate high rates of technical success, rapid symptom resolution and reduced intensive care stays. Ongoing challenges involve managing complex anatomies, preventing endoleaks and monitoring long-term device integrity. Multidisciplinary collaboration between vascular surgeons, interventional radiologists and anaesthetists is essential for patient selection, perioperative care and follow-up surveillance.

Research from Nature Portfolio

Recent studies have advanced the understanding of endovascular repair mechanisms and device performance in aortocaval fistulas. In one report, sophisticated computational fluid dynamics were used to model flow patterns within endografts, revealing how subtle adjustments in graft porosity can minimise residual shunting and improve seal integrity. Another investigation applied four-dimensional flow magnetic resonance imaging to patients before and after stent-graft placement, demonstrating rapid normalisation of venous inflow dynamics and quantifying reductions in caval wall stress. A further analysis examined the material fatigue behaviour of novel polymer-coated stents under pulsatile loading, highlighting design features that enhance long-term durability and reduce the risk of graft fracture in high-flow fistula scenarios.

Endovascular Management of Aortocaval Fistulas publication trend

The graph below shows the total number of articles in endovascular management of aortocaval fistulas across all publications each year (not limited to Nature Index journals).

Technical terms

Aortocaval fistula: An abnormal connection between the aorta and inferior vena cava, often due to aneurysm rupture, causing high-output cardiac failure.

Endovascular aneurysm repair (EVAR): A minimally invasive procedure that excludes an aneurysm by deploying a stent-graft within the vessel lumen.

Stent-graft: A tubular endovascular device combining a metallic scaffold and fabric covering to divert blood flow and seal vascular defects.

Computed tomography angiography (CTA): A radiological technique that visualises blood vessels by combining computed tomography with intravenous contrast.

Intravascular ultrasound (IVUS): A catheter-based imaging modality that provides cross-sectional views of vascular walls and luminal structures during endovascular procedures.